Complaint Form
Your Information (Complainant)
First Name *
Last Name *
Address
City
Province
Postal
Code
Email: *
Phone
Informatioin about the Reflexologist you are complaining about (Respondent)
Name of Reflexologist *
Date of Incident
Incident Location
Address
City
Postal Code
Province
Please describe your complaint in as much detail as possible. If your complaint spans multiple days, please record those dates here or upload a document describing the timeline. Please note all specific concerns about your treatment(s). *
Identify any persons, including other healthcare professionals, who may have witnessed or have information about your concerns (please provide their contact information)
Complaint Description *
Additional Information
Supporting_Documentation
Do you have any files to submit as part of this complaint? If you are submitting the form online, you may upload up to 10 files. Please provide copies of any supporting documents (e.g., receipts, text messages, e-mails, health records or other)
Acknowledgement *
I, as the complainant, agree to the following terms in submitting my complaint: *
1. I give permission to provide the information collected on this form to the college.
2. The informatioin provided will be used to process my complaint.
3. I understand that the complaint form and any attachments (excluding demographic information) may be shared with the Reflexologist for the purpose of complaint handling or enforcement. Your personal information will not be sold or shared for commercial purposes by the college.